Knowledge and attitudes toward anaphylaxis to local anesthetics in dental practice

Objective/aim The absence of a comprehensive understanding of potential anaphylactic reactions to local anesthetics (LAs) and management can result in grave consequences. For this reason we aim to assess Latin American dentists’ knowledge, preparedness, and competency in managing anaphylactic reactions to LAs. Materials and Methods Design: A cross-sectional study was conducted from November 2021 to February 2022. Board-certified dentists answered a survey comprising 26 structured questions. Chi-square tests and logistic regression models were performed in Stata 17.0. Setting: Argentina, Brazil, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Peru, Venezuela, and other Latin American countries. Results Of 507 respondents, lidocaine was the most frequently used LA (88.1%). While 85.2% could identify dyspnea as a symptom of anaphylaxis, only 50.1% knew the correct route for epinephrine administration, and just 43.5% had epinephrine in their emergency kits. Confidence in managing anaphylactic reactions was low (9.6%). Older age was inversely related to both knowledge of anaphylaxis management and the possession of epinephrine (P = 0.003 and P = 0.0001, respectively). Discussion Our study highlights a concerning discrepancy between the practical readiness of Latin American dentists in handling anaphylaxis. Conclusion The study’s findings underscore the need for educational interventions to improve the readiness to identify and handle anaphylactic emergencies in dental practice.

These are not "correct or incorrect" answers; they reflect the respondents' views or practices.However, there are some answers that align more closely with current medical guidelines.Below are those that generally align with these guidelines for the knowledge and attitude component of our survey: 1. What local anesthetic do you use?
 Lidocaine is commonly used, but all listed options are legitimate depending on the situation.

Do you prefer local anesthetics with epinephrine or without epinephrine?
 "With Epinephrine" is commonly used to prolong the duration of anesthesia and reduce bleeding, but both have their places.
3. Do you complete a clinical history of your patients before a procedure or treatment?
 "Yes" aligns with best practices for patient safety.

Do you routinely administer a test dose of local anesthetic?
 Practices may vary, but administering a test dose is generally not a standard practice for local anesthetics.

How do you behave when you care for a patient with a suspected allergy to local anesthesia?
 Referring the patient to an allergist is often considered the best practice.

How do you behave when caring for a patient who does not have drug allergies, but has other allergic conditions, such as asthma or allergic rhinitis?
 Considering these problems as a risk factor and possibly referring the patient to a specialist aligns with a cautious approach.

Have you ever seen a patient with a systemic adverse reaction caused by local anesthesia?
 This is a yes/no question, so there is no "correct" answer.

If you have seen a case of systemic adverse reaction caused by local anesthesia, did this occur during your treatment?
 This is also a yes/no question, so there is no "correct" answer.

What are the symptoms of an anaphylactic reaction during the application of local anesthetics?
 Dyspnea, Cutaneous Eruption, Edema, and Hypotension are generally associated with anaphylaxis.

After administering the test dose, what reaction is suspected of anaphylaxis?
 Dyspnea, Cutaneous reaction, and Hypotension are generally more associated with anaphylaxis than Syncope or Pruritus.

Which of the following medications do you have in your office?
 Epinephrine, Antihistamines, and Corticosteroids are often recommended for emergency situations.
12. What drug should be used as the first option to treat anaphylaxis?
 Epinephrine is the first-line treatment for anaphylaxis.

Which route do you prefer for the initial administration of epinephrine injection?
 Intramuscular is the recommended route for the initial administration of epinephrine for anaphylaxis.
Note that medical guidelines can change over time and may vary by jurisdiction.Always refer to the most current guidelines and consult medical professionals for the most accurate and personalized advice.
g) Do you ask your patients whether they got local anesthetic administration done prior for any do you behave when you see a patient with a suspected local anesthesia allergy?a) I do not begin the treatment a.I make a skin prick test with the suspected drug by myself b.I refer the patient to an allergy specialist with the suspected drug for testing c.I treat the patient without local anesthesia d.Others j) How do you behave when you see a patient without any drug allergy, but with any other allergic diseases, such as asthma or hay fever?a.I make the treatment without considering the other allergic problems b.I accept these problems as a risk factor and refer the patient to the specialist k) Have you ever seen a patient with systemic adverse reaction due to local anesthesia?a. Yes b.No l) If you have seen a case with systemic adverse reaction due to local anesthesia, has this occurred during your treatment?a. Yes b.No m) Which symptoms below remind you of anaphylaxis during your treatment?one of the drugs below do you keep in your office? of the above p) Which drug should be used as the first choice in management of anaphylaxis?

Table S1 .
Knowledge and Awareness Towards Anaphylaxis.

Table S2 .
Univariate Analysis Predicting Knowledge of Drug of Choice in Anaphylaxis.

Table S3 .
Univariate Logistic Regression Analyses Predicting the Possession of Epinephrine in Office

Table S4 .
Univariate Logistic Regression Analyses Predicting a Confident Attitude in Identifying Patients at Risk of Anaphylaxis